Poster: "ESCR 2015 / P-0026 / Spectrum of Findings of Sinus Venosus Atrial Septal Defect: CT... more Poster: "ESCR 2015 / P-0026 / Spectrum of Findings of Sinus Venosus Atrial Septal Defect: CT and MR Findings " by: "J. M. Madrid1, P. J. Mergo 2, P. Bartolome1, J. Phelan2, P. Parikh2, A. Bowman2, B. Shapiro2; 1Pamplona/ES, 2Jacksonville, FL/US"
Received April 23, 2014; accepted without revision May 26, 2014. a fraction of cryptogenic stroke... more Received April 23, 2014; accepted without revision May 26, 2014. a fraction of cryptogenic strokes may actually arise from a cardiac source that is undetectable with current methods [3]. In addition to appropriate cardiac monitoring for electrical abnormalities, echocardiography, particularly transthoracic echocardiography (TTE), is often the initial screening test for cardiac abnormalities in stroke patients [1]. Clear advantages of TTE are that the equipment is portable and that the procedure is noninvasive, widely available, and relatively inexpensive. However, in patients with suspected cardioembolism, TTE has a number of pitfalls. Although a few of the potential causes of cardiac emboli (e.g., LV thrombi) may be identified with TTE, it is rarely adequate for assessing aortic plaque and small valvular abnormalities and is not adequate for assessing LAA thrombi. Furthermore, technical challenges from poor acoustic windows are common, particularly in patients with obesity, chronic...
Cardiac magnetic resonance imaging (CMR) provides an important and complementary role to conventi... more Cardiac magnetic resonance imaging (CMR) provides an important and complementary role to conventional imaging in the evaluation of patients with pulmonary hypertension (PH). Echo-cardiography remains vital given its ability to quickly assess cardiac morphology, function, and hemodynamics. It is also portable, readily available, and relatively inexpensive. However, certain limitations of echocardiography do occur in PH patients such as inability to fully or accurately characterize the right ventricle (RV), which remains crucial for therapeutic decision making and prognostic determination. Given the geometric complexity of the RV as well as patient-specific factors such as obesity, echocardiography may fail to adequately depict the RV. Conversely, CMR is well suited for PH imaging for various reasons, not least of which is its ability to fully characterize RV morphology and function. In addition, CMR provides various components
Pulmonary arterial hypertension (PAH) is a disease of the pulmonary vasculature characterized by ... more Pulmonary arterial hypertension (PAH) is a disease of the pulmonary vasculature characterized by increased stiffness secondary to deleterious remodeling. High resistance and worsened PA compliance causes adverse ventricular-arterial (VA) coupling, leading to excessive afterload and right ventricular dysfunction.
There are increasing reports of a type of lung cancer that manifests as solitary cystic airspaces... more There are increasing reports of a type of lung cancer that manifests as solitary cystic airspaces. The purpose of this case series was to identify the CT features and possible mechanisms of solitary cystic lung cancer, on the basis of CT observations and pathologic characteristics. The clinical, imaging, and pathologic data of 106 patients with solitary cystic lung cancer were collected and analyzed between January 2011 and December 2017. CT images were reviewed independently by three radiologists who were blinded to pathologic findings. Demographic data and clinical and smoking status were extracted from the medical records. The mean age was 58.8 years 6 10.6 (standard deviation) (range, 30-82 years). CT features in the 106 patients included nonuniform cystic walls in 96 (90.6%) patients, cyst septations in 62 (58.5%) patients, nodular walls in 58 (54.7%) patients, ground-glass opacity around the cyst in 53 patients (50.0%), and irregular margins in 42 (39.6%) patients. At histologic examination, the majority of cases (81 [87.1%] of 93) were adenocarcinoma.
the minimum and maximum score values are 1.87 and 11.37, respectively, for the standardized PMR-A... more the minimum and maximum score values are 1.87 and 11.37, respectively, for the standardized PMR-AS (supplementary Fig. S3, available at Rheumatology online) vs 0.96 and 9, respectively, for the RA-DAS28. We arbitrarily chose the 3.2 and 5.1 cutoffs for the standardized scoring system. Other cutoffs , such as 10 and 20, could be used. In a perfect world, all disease activity should be graduate between 0 and 10, with similar cutoffs , in order to allow an easier interpretation. Importantly, the values indicating a remission and the minimum and maximum values are different with the standardized and conventional scoring systems. However, the standardized system produces a similar wide range of values and facilitates the task of interpreting activity scores for various diseases. Developing these new criteria needs validation on various datasets and then a computer or cellphone application could be developed to help clinicians who want to use the standardized scoring system, should the rheumatology community agree with our suggestions.
A 57-year-old woman presented to the emergency department with focal, sharp pain radiating to her... more A 57-year-old woman presented to the emergency department with focal, sharp pain radiating to her back for one month. Past medical history was significant for hypertension, hyperlipidemia, tobacco use, and extensive peripheral arterial disease. A lateral chest X-ray revealed a posterior convexity projecting off the proximal descending aorta (Figure 1). Given her renal insufficiency, a magnetic resonance angiogram (MRA) was performed using ferumoxytol. It demonstrated a large 2.0 2.5 cm penetrating aortic ulcer on the lateral proximal descending thoracic aorta (Figure 2). Following hydration protocol, this was later demonstrated on a computed tomography angiogram (CTA) in anticipation of percutaneous repair (Figure 3a-c). The patient underwent repair with placement of an endoluminal aortic stent graft with immediate resolution of chest pain (Figure 4). She remained chest pain free at her one month follow-up appointment.
PURPOSE/AIM An understanding of the anatomy of the left atrial appendage (LAA) is becoming increa... more PURPOSE/AIM An understanding of the anatomy of the left atrial appendage (LAA) is becoming increasingly important as it is recognized as a significant site for thrombus. Advanced techniques for LAA closure (including the Larait and Watchman procedures, as well as surgical closure) require precise anatomic localization and description of the LAA and its anatomic relationships prior to intervention. To date, this is not well described in the literature. CONTENT ORGANIZATION This scientific exhibit describes the anatomy of the LAA, as imaged with CTA, including parameters for normal size and positioning of the LAA relative to the heart. Additionally, the anatomic relationships are discussed in context of their impact on pre-procedural planning for LAA closure, including a detailed discussion of the Lariat, Watchman and surgical techniques. Specific teaching points are made emphasizing the relevant findings on CTA as they relate to pre-procedural planning. Finally, imaging techniques ar...
PURPOSE/AIM 1. Briefly review the physiology of pulmonary arterial hemodynamics 2. Review imaging... more PURPOSE/AIM 1. Briefly review the physiology of pulmonary arterial hemodynamics 2. Review imaging manifestations of pulmonary hypertension and abnormal flow dynamics affecting the pulmonary artery CONTENT ORGANIZATION Review of pulmonary artery physiology. - Hemodynamics of pulmonary arterial circulation - Effects of abnormal pressure or flow on the central pulmonary arteries - Effects of the activation of pulmonary vascular endothelium and the inflammatory response Imaging manifestations of pulmonary hypertension - Findings in primary peripheral pulmonary hypertension, chronic pulmonary thromboembolic disease, portopulmonary hypertension - Quantification of PA pulsatility as a surrogate for compliance - PA and RV size - Signs of RV strain Imaging manifestations of abnormal flow phenomena affecting the pulmonary artery - Left to right shunt: ASD, VSD, PDA, anomalous pulmonary venous return - Pulmonary stenosis or regurgitation - Quantification of shunt or regurgitant fraction SUMMAR...
To determine the radiation effective dose to adult and pediatric patients undergoing abdominal co... more To determine the radiation effective dose to adult and pediatric patients undergoing abdominal computed tomographic (CT) examinations. Technique factors were obtained for three groups of randomly selected patients undergoing abdominal CT examinations: 31 children aged 10 years or younger; 32 young adults aged 11-18 years; and 36 adults older than 18 years. The radiographic techniques, together with the measured cross sections of patients, were used to estimate the total energy imparted to each patient. Each value of energy imparted was subsequently converted into the corresponding effective dose to the patient, taking into account the mass of the patient. All abdominal CT examinations were performed at 120 kVp with a section thickness of approximately 7 mm for all sizes of patients. The mean number of CT sections increased from 22.0 for children to 31.5 for adults, and the mean quantity of x radiation in milliampere-seconds increased from 220 mAs for children to 290 mAs for adults. The mean values (+/- SD) of energy imparted were 72.1 mJ +/- 24.4 for children, 183.5 mJ +/- 44.8 for young adults, and 234.7 mJ +/- 89.4 for adults. The corresponding mean values of patient effective dose were 6.1 mSv +/- 1.4 for children, 4.4 mSv +/- 1.0 for young adults, and 3.9 mSv +/- 1.1 for adults. Values of energy imparted to patients undergoing abdominal CT examinations were a factor of three higher in adults than in children, but the corresponding patient effective doses were 50% higher in children than in adults.
Please indicate your field(s) of expertise (pulmonary, cardiology, cardiothoracic surgery, critic... more Please indicate your field(s) of expertise (pulmonary, cardiology, cardiothoracic surgery, critical care, or sleep), and include your curriculum vitae if available. In appreciation for completed reviews, authors may retain the book or software for their own use.
purposeof this studyis to evaluatethe clinical significanceof radio graphiccardiomegalyin orthoto... more purposeof this studyis to evaluatethe clinical significanceof radio graphiccardiomegalyin orthotopichearttransplantrecipientsand to identify causativeana tomic and physiologic parameters.
The International Journal of Cardiovascular Imaging, 2018
Early detection of mild pulmonary arterial hypertension (PAH) based on clinical evaluation and ec... more Early detection of mild pulmonary arterial hypertension (PAH) based on clinical evaluation and echocardiography remains quite challenging. In addition to enhanced right ventricular (RV) assessment, cardiac magnetic resonance (CMR) imaging may accurately reflect deleterious remodeling and increased stiffness of the central pulmonary arteries based on pulsatility, or percent change of the PA during the cardiac cycle. The purpose of this study is to assess the utility of measuring PA pulsatility by CMR as a potential early maker in PAH. We hypothesize that pulsatility may help discriminate mild PAH from normal control subjects. Consecutive patients with PAH (n = 51) were prospectively enrolled to receive same day CMR and right heart catheterization (RHC). PA stiffness indices including pulsatility, distensibility, compliance, and capacitance were calculated. Comparisons were made between patients with varying severities of PAH and normal controls (n = 18). Of the 51 subjects, 20 had mild PAH, and 31 moderate-severe based on hemodynamic criteria. PA pulsatility demonstrated a progressive decline from normal controls (53%), mild PAH (22%), to moderate-severe PAH (17%; p < 0.001). There was no difference in RV size, function or mass between mild PAH and normal controls. PA pulsatility below 40% had an excellent ability to discriminate between mild PAH and normal controls with a sensitivity of 95% and specificity of 94%. CMR assessment of PA stiffness may noninvasively detect adverse pulmonary vascular remodeling and mild PAH, and thus be a valuable tool for early detection of PAH. Trial Registration: ClinicalTrials.gov Identifier: NCT01451255; https ://clini caltr ials.gov/ct2/show/NCT01 45125 5.
Journal of the American College of Cardiology, 2019
Background: Cardiac magnetic resonance (CMR) imaging in pulmonary arterial hypertension (PAH) may... more Background: Cardiac magnetic resonance (CMR) imaging in pulmonary arterial hypertension (PAH) may aid in assessment of right ventricular (RV) morphology and function as well as contractile reserve (RVCR). Previous data suggests that RVCR may be diminished in patients with PAH patients by bicycle ergometer (eCMR). We hypothesized that treadmill eCMR may also demonstrate poor RVCR in PAH participants and provide incremental data beyond resting CMR. Methods: Patients with group I PAH (n=18) were prospectively enrolled for same day eCMR and exercise right heart catheterization (eRHC). The eCMR consisted of upright treadmill by Naughton protocol with pre-and post-free breathing cine image acquisition. RV volumes and EF were measured at rest and following treadmill stress testing. The eRHC utilized hemodynamic measurements including mean PA pressure (mPAP) at rest and peak exercise using a cycle ergometer. Patients were compared based on whether RVCR improved (RVEF >10%), remained unchanged, or worsened (RVEF <10%). Various statistical methods were used to compare hemodynamics and eCMR parameters including t-tests and chi-squared. Results: Of the 18 subjects, 5 (28%) demonstrated RVCR with a mean increase in RVEF of 11% (10-16%) compared to a mean reduction in RVEF of 8% in in the non-RVCR group (p<0.001). Patients with RVCR had higher 6min walk distances (513m vs. 390m, p<0.001), had no difference in change of mPAP from rest to peak exercise (difference of 23mmHg vs 22mmHg, p=0.6540). In addition, patients with RVCR were on more PAH medications (3.2 vs 2.2) and all patients with RVCR were receiving prostanoid therapy compared to only 15% in the non-RVCR group. Conclusion: eCMR assessment of RVCR is feasible using upright treadmill exercise and free-breathing cine acquisition and demonstrated improvement or worsening of RVCR during upright treadmill exercise. Patients who were on at least 3 PAH medications including a prostanoid were more likely to have RVCR compared to those who are not on those therapies. A larger study population is necessary to explore the relationship between drug therapy and RVCR.
Poster: "ESCR 2015 / P-0026 / Spectrum of Findings of Sinus Venosus Atrial Septal Defect: CT... more Poster: "ESCR 2015 / P-0026 / Spectrum of Findings of Sinus Venosus Atrial Septal Defect: CT and MR Findings " by: "J. M. Madrid1, P. J. Mergo 2, P. Bartolome1, J. Phelan2, P. Parikh2, A. Bowman2, B. Shapiro2; 1Pamplona/ES, 2Jacksonville, FL/US"
Received April 23, 2014; accepted without revision May 26, 2014. a fraction of cryptogenic stroke... more Received April 23, 2014; accepted without revision May 26, 2014. a fraction of cryptogenic strokes may actually arise from a cardiac source that is undetectable with current methods [3]. In addition to appropriate cardiac monitoring for electrical abnormalities, echocardiography, particularly transthoracic echocardiography (TTE), is often the initial screening test for cardiac abnormalities in stroke patients [1]. Clear advantages of TTE are that the equipment is portable and that the procedure is noninvasive, widely available, and relatively inexpensive. However, in patients with suspected cardioembolism, TTE has a number of pitfalls. Although a few of the potential causes of cardiac emboli (e.g., LV thrombi) may be identified with TTE, it is rarely adequate for assessing aortic plaque and small valvular abnormalities and is not adequate for assessing LAA thrombi. Furthermore, technical challenges from poor acoustic windows are common, particularly in patients with obesity, chronic...
Cardiac magnetic resonance imaging (CMR) provides an important and complementary role to conventi... more Cardiac magnetic resonance imaging (CMR) provides an important and complementary role to conventional imaging in the evaluation of patients with pulmonary hypertension (PH). Echo-cardiography remains vital given its ability to quickly assess cardiac morphology, function, and hemodynamics. It is also portable, readily available, and relatively inexpensive. However, certain limitations of echocardiography do occur in PH patients such as inability to fully or accurately characterize the right ventricle (RV), which remains crucial for therapeutic decision making and prognostic determination. Given the geometric complexity of the RV as well as patient-specific factors such as obesity, echocardiography may fail to adequately depict the RV. Conversely, CMR is well suited for PH imaging for various reasons, not least of which is its ability to fully characterize RV morphology and function. In addition, CMR provides various components
Pulmonary arterial hypertension (PAH) is a disease of the pulmonary vasculature characterized by ... more Pulmonary arterial hypertension (PAH) is a disease of the pulmonary vasculature characterized by increased stiffness secondary to deleterious remodeling. High resistance and worsened PA compliance causes adverse ventricular-arterial (VA) coupling, leading to excessive afterload and right ventricular dysfunction.
There are increasing reports of a type of lung cancer that manifests as solitary cystic airspaces... more There are increasing reports of a type of lung cancer that manifests as solitary cystic airspaces. The purpose of this case series was to identify the CT features and possible mechanisms of solitary cystic lung cancer, on the basis of CT observations and pathologic characteristics. The clinical, imaging, and pathologic data of 106 patients with solitary cystic lung cancer were collected and analyzed between January 2011 and December 2017. CT images were reviewed independently by three radiologists who were blinded to pathologic findings. Demographic data and clinical and smoking status were extracted from the medical records. The mean age was 58.8 years 6 10.6 (standard deviation) (range, 30-82 years). CT features in the 106 patients included nonuniform cystic walls in 96 (90.6%) patients, cyst septations in 62 (58.5%) patients, nodular walls in 58 (54.7%) patients, ground-glass opacity around the cyst in 53 patients (50.0%), and irregular margins in 42 (39.6%) patients. At histologic examination, the majority of cases (81 [87.1%] of 93) were adenocarcinoma.
the minimum and maximum score values are 1.87 and 11.37, respectively, for the standardized PMR-A... more the minimum and maximum score values are 1.87 and 11.37, respectively, for the standardized PMR-AS (supplementary Fig. S3, available at Rheumatology online) vs 0.96 and 9, respectively, for the RA-DAS28. We arbitrarily chose the 3.2 and 5.1 cutoffs for the standardized scoring system. Other cutoffs , such as 10 and 20, could be used. In a perfect world, all disease activity should be graduate between 0 and 10, with similar cutoffs , in order to allow an easier interpretation. Importantly, the values indicating a remission and the minimum and maximum values are different with the standardized and conventional scoring systems. However, the standardized system produces a similar wide range of values and facilitates the task of interpreting activity scores for various diseases. Developing these new criteria needs validation on various datasets and then a computer or cellphone application could be developed to help clinicians who want to use the standardized scoring system, should the rheumatology community agree with our suggestions.
A 57-year-old woman presented to the emergency department with focal, sharp pain radiating to her... more A 57-year-old woman presented to the emergency department with focal, sharp pain radiating to her back for one month. Past medical history was significant for hypertension, hyperlipidemia, tobacco use, and extensive peripheral arterial disease. A lateral chest X-ray revealed a posterior convexity projecting off the proximal descending aorta (Figure 1). Given her renal insufficiency, a magnetic resonance angiogram (MRA) was performed using ferumoxytol. It demonstrated a large 2.0 2.5 cm penetrating aortic ulcer on the lateral proximal descending thoracic aorta (Figure 2). Following hydration protocol, this was later demonstrated on a computed tomography angiogram (CTA) in anticipation of percutaneous repair (Figure 3a-c). The patient underwent repair with placement of an endoluminal aortic stent graft with immediate resolution of chest pain (Figure 4). She remained chest pain free at her one month follow-up appointment.
PURPOSE/AIM An understanding of the anatomy of the left atrial appendage (LAA) is becoming increa... more PURPOSE/AIM An understanding of the anatomy of the left atrial appendage (LAA) is becoming increasingly important as it is recognized as a significant site for thrombus. Advanced techniques for LAA closure (including the Larait and Watchman procedures, as well as surgical closure) require precise anatomic localization and description of the LAA and its anatomic relationships prior to intervention. To date, this is not well described in the literature. CONTENT ORGANIZATION This scientific exhibit describes the anatomy of the LAA, as imaged with CTA, including parameters for normal size and positioning of the LAA relative to the heart. Additionally, the anatomic relationships are discussed in context of their impact on pre-procedural planning for LAA closure, including a detailed discussion of the Lariat, Watchman and surgical techniques. Specific teaching points are made emphasizing the relevant findings on CTA as they relate to pre-procedural planning. Finally, imaging techniques ar...
PURPOSE/AIM 1. Briefly review the physiology of pulmonary arterial hemodynamics 2. Review imaging... more PURPOSE/AIM 1. Briefly review the physiology of pulmonary arterial hemodynamics 2. Review imaging manifestations of pulmonary hypertension and abnormal flow dynamics affecting the pulmonary artery CONTENT ORGANIZATION Review of pulmonary artery physiology. - Hemodynamics of pulmonary arterial circulation - Effects of abnormal pressure or flow on the central pulmonary arteries - Effects of the activation of pulmonary vascular endothelium and the inflammatory response Imaging manifestations of pulmonary hypertension - Findings in primary peripheral pulmonary hypertension, chronic pulmonary thromboembolic disease, portopulmonary hypertension - Quantification of PA pulsatility as a surrogate for compliance - PA and RV size - Signs of RV strain Imaging manifestations of abnormal flow phenomena affecting the pulmonary artery - Left to right shunt: ASD, VSD, PDA, anomalous pulmonary venous return - Pulmonary stenosis or regurgitation - Quantification of shunt or regurgitant fraction SUMMAR...
To determine the radiation effective dose to adult and pediatric patients undergoing abdominal co... more To determine the radiation effective dose to adult and pediatric patients undergoing abdominal computed tomographic (CT) examinations. Technique factors were obtained for three groups of randomly selected patients undergoing abdominal CT examinations: 31 children aged 10 years or younger; 32 young adults aged 11-18 years; and 36 adults older than 18 years. The radiographic techniques, together with the measured cross sections of patients, were used to estimate the total energy imparted to each patient. Each value of energy imparted was subsequently converted into the corresponding effective dose to the patient, taking into account the mass of the patient. All abdominal CT examinations were performed at 120 kVp with a section thickness of approximately 7 mm for all sizes of patients. The mean number of CT sections increased from 22.0 for children to 31.5 for adults, and the mean quantity of x radiation in milliampere-seconds increased from 220 mAs for children to 290 mAs for adults. The mean values (+/- SD) of energy imparted were 72.1 mJ +/- 24.4 for children, 183.5 mJ +/- 44.8 for young adults, and 234.7 mJ +/- 89.4 for adults. The corresponding mean values of patient effective dose were 6.1 mSv +/- 1.4 for children, 4.4 mSv +/- 1.0 for young adults, and 3.9 mSv +/- 1.1 for adults. Values of energy imparted to patients undergoing abdominal CT examinations were a factor of three higher in adults than in children, but the corresponding patient effective doses were 50% higher in children than in adults.
Please indicate your field(s) of expertise (pulmonary, cardiology, cardiothoracic surgery, critic... more Please indicate your field(s) of expertise (pulmonary, cardiology, cardiothoracic surgery, critical care, or sleep), and include your curriculum vitae if available. In appreciation for completed reviews, authors may retain the book or software for their own use.
purposeof this studyis to evaluatethe clinical significanceof radio graphiccardiomegalyin orthoto... more purposeof this studyis to evaluatethe clinical significanceof radio graphiccardiomegalyin orthotopichearttransplantrecipientsand to identify causativeana tomic and physiologic parameters.
The International Journal of Cardiovascular Imaging, 2018
Early detection of mild pulmonary arterial hypertension (PAH) based on clinical evaluation and ec... more Early detection of mild pulmonary arterial hypertension (PAH) based on clinical evaluation and echocardiography remains quite challenging. In addition to enhanced right ventricular (RV) assessment, cardiac magnetic resonance (CMR) imaging may accurately reflect deleterious remodeling and increased stiffness of the central pulmonary arteries based on pulsatility, or percent change of the PA during the cardiac cycle. The purpose of this study is to assess the utility of measuring PA pulsatility by CMR as a potential early maker in PAH. We hypothesize that pulsatility may help discriminate mild PAH from normal control subjects. Consecutive patients with PAH (n = 51) were prospectively enrolled to receive same day CMR and right heart catheterization (RHC). PA stiffness indices including pulsatility, distensibility, compliance, and capacitance were calculated. Comparisons were made between patients with varying severities of PAH and normal controls (n = 18). Of the 51 subjects, 20 had mild PAH, and 31 moderate-severe based on hemodynamic criteria. PA pulsatility demonstrated a progressive decline from normal controls (53%), mild PAH (22%), to moderate-severe PAH (17%; p < 0.001). There was no difference in RV size, function or mass between mild PAH and normal controls. PA pulsatility below 40% had an excellent ability to discriminate between mild PAH and normal controls with a sensitivity of 95% and specificity of 94%. CMR assessment of PA stiffness may noninvasively detect adverse pulmonary vascular remodeling and mild PAH, and thus be a valuable tool for early detection of PAH. Trial Registration: ClinicalTrials.gov Identifier: NCT01451255; https ://clini caltr ials.gov/ct2/show/NCT01 45125 5.
Journal of the American College of Cardiology, 2019
Background: Cardiac magnetic resonance (CMR) imaging in pulmonary arterial hypertension (PAH) may... more Background: Cardiac magnetic resonance (CMR) imaging in pulmonary arterial hypertension (PAH) may aid in assessment of right ventricular (RV) morphology and function as well as contractile reserve (RVCR). Previous data suggests that RVCR may be diminished in patients with PAH patients by bicycle ergometer (eCMR). We hypothesized that treadmill eCMR may also demonstrate poor RVCR in PAH participants and provide incremental data beyond resting CMR. Methods: Patients with group I PAH (n=18) were prospectively enrolled for same day eCMR and exercise right heart catheterization (eRHC). The eCMR consisted of upright treadmill by Naughton protocol with pre-and post-free breathing cine image acquisition. RV volumes and EF were measured at rest and following treadmill stress testing. The eRHC utilized hemodynamic measurements including mean PA pressure (mPAP) at rest and peak exercise using a cycle ergometer. Patients were compared based on whether RVCR improved (RVEF >10%), remained unchanged, or worsened (RVEF <10%). Various statistical methods were used to compare hemodynamics and eCMR parameters including t-tests and chi-squared. Results: Of the 18 subjects, 5 (28%) demonstrated RVCR with a mean increase in RVEF of 11% (10-16%) compared to a mean reduction in RVEF of 8% in in the non-RVCR group (p<0.001). Patients with RVCR had higher 6min walk distances (513m vs. 390m, p<0.001), had no difference in change of mPAP from rest to peak exercise (difference of 23mmHg vs 22mmHg, p=0.6540). In addition, patients with RVCR were on more PAH medications (3.2 vs 2.2) and all patients with RVCR were receiving prostanoid therapy compared to only 15% in the non-RVCR group. Conclusion: eCMR assessment of RVCR is feasible using upright treadmill exercise and free-breathing cine acquisition and demonstrated improvement or worsening of RVCR during upright treadmill exercise. Patients who were on at least 3 PAH medications including a prostanoid were more likely to have RVCR compared to those who are not on those therapies. A larger study population is necessary to explore the relationship between drug therapy and RVCR.
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Papers by Patricia Mergo